Rotator Cuff Tears (and their repair)

A tear in the rotator cuff tendons may develop either because of an injury to the shoulder or as a degenerative process whereby the protein in the tendon thins with age and activity analogous to a pair of socks wearing out and developing a hole. This can happen suddenly or gradually creep up on a patient over many months. Either way the shoulder is painful at rest but especially with activity and catches with certain movements. There may be a feeling of weakness in that the shoulder lacks the strength to lift heavy items.

Investigations You May Require

Your doctor may recommend investigation by ultrasound scan (a probe with jelly on the skin) or MRI scan (lying still inside the body scanner) as well as plain x-rays. The scans are to help confirm the diagnosis, identify the site and size of a tear and help in planning treatment.

Rupture of the Rotator Cuff

TREATMENT

Initial treatment may involve rest and painkilling tablets such as paracetamol and codeine or anti- inflammatories such as ibuprofen or diclofenac. A trial of physiotherapy treatment is often a good idea, particularly with degenerative tears, to optimise the function and strength of remaining shoulder muscles with strengthening control exercises.

Some doctors or physiotherapists may recommend an injection of steroid and local anaesthetic to the shoulder to complement such treatment programmes.

A shoulder surgeon may recommend an operation to repair the torn tendon. Stitches are used to repair the torn tendon to itself and to the bone. Often little anchors are placed into the bone with a combination of stitches attached to fix the edge of the tendon down to the bone.

Repair of the Rotator Cuff

Such repair surgery is usually performed in combination with a standard subacromial decompression. This is commonly a keyhole surgery operation performed under general anaesthetic and usually as a day-case procedure. Using a telescope through small stab incisions around the shoulder it is possible for the surgeon to inspect all parts of the shoulder and perform the repair procedure.

The operation is performed under general anaesthetic usually in combination with a nerve block performed into the neck by the anaesthetist to help with pain relief.

The simple stitches are removed at 2 weeks but a shoulder abduction brace or shoulder sling is usually required for 4-6 weeks after surgery to protect the repair.

Success Rates and Rehabilitation Programme

The operation has good success rates but patients require a strict course of physiotherapy rehabilitation to gain maximum benefit. The patient’s biology still has to heal the tendon to the bone and until that happens activities must be restricted.

Driving is allowed as soon as a patient feels safe and able to do so after the sling is discarded – usually between 4-6 weeks. Return to work is dependent on the activities required – sedentary work 6 weeks, heavy manual work 3 months.

Risks

The risks of infection and wound problems are minimal (less than 1%).

Occasionally the large size of a tear or poor quality of the tendon tissue precludes a complete repair. In such cases the surgeon may perform a partial repair or simply a ‘tidy up’ operation perhaps including release of the biceps tendon. Such alternatives can also be very effective in reducing pain and function can be optimised with specific physiotherapy.